The nurse is caring for a client following the removal of a central line catheter when the client suddenly develops dyspnoea and complains of substernal chest pain. The client is noticeably confused and fearful. The nurse should suspect which complication of central line use?

1. A

   Myocardial infarction

2. B

   Air embolus

3. C

   Intrathoracic bleeding

4. D

   Vagal response

Appeared in: DHS 2018 shift 1st

Explanation

• An air embolus occurs when air enters the venous system, which is a known risk during central line removal if the tract is not properly occluded.
• The negative intrathoracic pressure generated during inhalation can draw air into the open vein, creating an air lock in the right ventricle and pulmonary artery.
• This obstruction of blood flow to the lungs leads to a sudden onset of severe respiratory distress (dyspnea), chest pain, hypoxia, and neurological changes (confusion, fear), matching the client's presentation.
• The combination of the procedure (CVC removal) and the specific, acute symptoms makes air embolus the most probable diagnosis.

Why Other Options Were Wrong

• Option A: While a myocardial infarction (MI) can cause chest pain and dyspnea, it is not a direct mechanical complication of CVC removal. The immediate onset of symptoms post-procedure strongly points to an iatrogenic cause like an embolism.
• Option C: Intrathoracic bleeding is a significant risk during the insertion of a central line, where major vessels or the pleura can be accidentally punctured. It is not a typical complication of catheter removal.
• Option D: A vagal response is characterized by bradycardia, hypotension, lightheadedness, and syncope. It does not cause the profound respiratory distress, chest pain, and acute confusion described in the scenario.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Complications of Central Venous Catheter (CVC) Removal to guide bedside assessment, documentation, and the next nursing action.
• Recognizing the signs of an air embolism after CVC removal is a critical nursing skill, as immediate intervention is required to prevent cardiovascular collapse and death.
• The primary nursing action is to position the patient in the left lateral Trendelenburg position. This traps the air in the right ventricle, preventing it from entering the pulmonary circulation and causing a fatal obstruction.
• What if? If the patient was instructed to perform the Valsalva maneuver (bear down) during catheter removal, the risk of air embolism would be significantly reduced because this maneuver increases intrathoracic pressure, preventing air from being sucked into the vein.

How to Approach the Question

• First, identify the key event: removal of a central line catheter.
• Next, analyze the patient's symptoms: sudden dyspnea, substernal chest pain, confusion, and fear. Note the acute and immediate onset.
• Connect the procedure to the symptoms. Ask yourself, 'Which complication of CVC removal can cause this specific cluster of acute cardiorespiratory and neurological signs?'
• Evaluate each option based on this connection. An air embolus directly explains how air entering the circulation during removal causes these exact symptoms.
• Rule out the other options. Bleeding is an insertion risk. A vagal response has different symptoms (bradycardia, syncope). An MI is less likely to be directly caused by the removal itself.
• Select the option that provides the most direct and plausible explanation for the clinical picture presented.

Concept Tested & Keywords

• Concept Tested: Complications of Central Venous Catheter (CVC) Removal
• Stem keywords: central line catheter removal, suddenly develops dyspnoea, substernal chest pain, confused and fearful
• Lead-in keywords: suspect which complication
• Clinical cues: The timing of symptom onset (immediately after CVC removal) is the most critical clue, pointing to a direct procedural complication.

Question ID

Qb9DYNQ2nU4bleOChCxKqt

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Reference Book

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 1 (1-214) p. 207-209

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 53-55

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 199-201